How large is the chiropractic profession?
Chiropractic is the fastest-growing and second-largest primary health care profession. According to Federation of Chiropractic Licensing Boards there are approximately 81,000 doctors of chiropractic (DCs) in active practice in the United States spread from rural areas to inner cities. More than 10,000 students are currently enrolled in chiropractic educational programs accredited by a federally-recognized body (CCE). The ratio of DCs to the general population, based on the Bureau of the Census figures is estimated to be one doctor of chiropractic for every 5,100 citizens. This compared dramatically to the ratio of medical providers to the general population as there are well over ten times more MDs than DCs. Thus the MD to general population ratio is approximately one to every 430 citizens.

How many people see chiropractors?
Chiropractic services are in high demand. Tens of millions of Americans routinely opt for chiropractic services and this number is rapidly growing. In 2003, more than 40 million consumers made chiropractic a regular part of their health care program.

Are chiropractors educated as well medical doctors (MDs) and osteopaths (DOs)?
To receive the doctor of chiropractic degree, candidates must complete extensive undergraduate prerequisites and four years of graduate-level instruction and internship at an accredited chiropractic institution. Comprehensive knowledge of all systems of the body and diagnostic procedures enable the DC to thoroughly evaluate a patient, address disorders relating to the spine and determine the need for referral to another health care provider.

Do I have to see my medical doctor before I see a chiropractor?
No. Doctors of Chiropractic are primary health care providers. According to the Center for Studies in Health Policy, "The DC can provide all three levels of primary care interventions and therefore is a primary care provider, as are MDs and DOs. The doctor of chiropractic is a gatekeeper to the health care system and an independent practitioner who provides primary care services. The DC's office is a direct access portal of entry to the full scope of service."

Does a chiropractor have to have a license to practice?
Doctors of Chiropractic are licensed in all 50 states. DCs have been licensed and recognized for many decades in all states, the District of Columbia and Puerto Rico.

Is chiropractic recognized by government agencies?
Chiropractic is recognized by governmental health care programs. Chiropractic is included in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal Workers' Compensation and all state workers' compensation programs. Chiropractic students are qualified to receive federal student loan assistance and DCs are authorized to be commissioned as health care officers in the U.S. Armed Forces.

I've heard that chiropractic really doesn't have a scientific basis. What are the facts?
The practice of chiropractic is based on sound scientific principles.
The existence of the nervous system as the primary control mechanism of the body is an undisputed scientific fact. Its relationship with the spine is the focus of the practice of chiropractic. The spine develops in utero to provide two primary functions: (1) allow for freedom of movement and (2) house and protect the spinal cord. When the vertebrae of the spine become misaligned through trauma or repetitive injury, two major consequences will result: (1) the range of motion becomes limited and (2) spinal nerves emerging from the spinal cord are compromised. DCs use the term "subluxation" to describe such disruptions.  Interruption of nerve flow can eventually lead to pain, disability, and an overall decrease in the quality of life. Conversely, the removal of that interference has been shown to have significant, lasting health benefits. Through the adjustment of the subluxation, the doctor of chiropractic endeavors to restore normal nerve expression. The body is then able to respond appropriately to any imbalance in the system, thus relieving symptoms and restoring health.

Is chiropractic care expensive?
Doctors of chiropractic provide effective, low-cost health care for a wide range of conditions.

Studies conducted according to the highest scientific standards and published by organizations not affiliated in any way with chiropractic institutions or associations continue to show the clinical appropriateness and effectiveness of chiropractic care. One of the most recent, funded by the Ontario Ministry of Health, stated emphatically that:

"On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain...There would be highly significant cost savings if more management of low back pain was transferred from physician to chiropractors.

Does chiropractic treat any other problems except back problems?
The doctor of chiropractic is an effective source of preventative and wellness care. The anatomical focus of the DC on the human spine has created the perception of the DC as just a "back doctor." Although this perception is not entirely incorrect, it is very much incomplete. Doctors of chiropractic are a highly appropriate resource in matters of work-place safety, stress management, injury prevention, postural correction and nutritional counseling.

Could I be hurt by chiropractic care? Is it really safe?
The process of chiropractic adjustment is a safe, efficient procedure which is performed nearly one million times every working day in the United States.

There is a singular lack of actuarial data that would justify concluding that chiropractic care is in any way harmful or dangerous. Chiropractic care is non-invasive, therefore, the body's response to chiropractic care is far more predictable than its reactions to drug treatments or surgical procedures and medical studies show that more than 250,000 people die every year from properly prescribed drugs.  Of the nearly one million adjustments given every day in this country, complications are exceedingly rare. Perhaps the best summary statement on the subject of safety was published in 1979 by the Government of New Zealand which established a special commission to study chiropractic. They found:

"The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record."

Hands-on experience - Chiropractic is both safe and effective, says Peter Dixon
A man suffering with chronic back pain was persuaded by his partner earlier this year to consult a chiropractor about his condition. His visit to a local chiropractic clinic coincided with an article in a national newspaper about the risks of chiropractic treatment.  He arrived at the clinic brandishing the article and refusing treatment. The article echoed much that Edzard Ernst, professor of complementary medicine at the University of Exeter, had written two months earlier in this magazine (Forum, 18 April, p 49).

Chiropractors diagnose and treat conditions caused by the mechanical dysfunction of joints and the effects these have on the nervous system. The tendency of the media to warn that danger surrounds the specialized manipulative techniques chiropractors use does not instill confidence. Nor does the confusing variation in chiropractic's legal status. In Britain, for example, chiropractors can practice legally because no law stops them doing so. In Spain, Belgium and France a licence is needed to practice any form of medicine. To get such a licence, a conventional medical qualification is needed.

To confuse things further, people in Britain can call themselves chiropractors whether they are qualified or not. But following the Chiropractors Act of 1994, the General Chiropractic Council will soon open its "statutory register". Thereafter only registered practitioners will legally be able to call themselves chiropractors in Britain. Similar regulations already exist in Australia, Denmark, Sweden and the US.

Like other forms of healthcare that do not involve drugs, chiropractic does not attract the sort of funding that pharmaceuticals companies allocate to research. But scientific evidence for the effectiveness and safety of chiropractic is growing, and practitioners are demonstrating this through peer-reviewed research.

In 1990, a detailed study on low back pain was published in the British Medical Journal (vol 300, p 1431). It compared chiropractic with hospital outpatient treatment for managing low back  pain. It demonstrated that chiropractic was the more effective of the two. A follow-up study in 1995 confirmed this conclusion, reporting a 29 per cent improvement level for chiropractic over hospital treatment (BMJ, vol 311, p 349).

In 1997, at the World Chiropractic Congress in Tokyo, Danish researchers presented results showing that chiropractic reduced the duration of headaches by 69 per cent (compared with 37 per cent for massage) and their intensity by 36 per cent (compared with 17 per cent for massage). It also reduced the number of painkillers needed by 36 per cent. And a Dutch study shows that for shoulder pain arising from disorders of the spine or upper ribs, chiropractic manipulation has very positive effects (BMJ, vol 314, p 1320). But despite such evidence, the case for the profession is confounded by inaccurate use of the term chiropractic. In 1995, Alan Terrett, an Australian professor of health science, reviewed the published research on the complications of chiropractic neck manipulation. On contacting the original authors and patients, he found that many reported incidents were not severe at all and that many of the "chiropractic manipulations" were not performed by chiropractors.

The risks of chiropractic should be put in perspective. The Independent's article said that "chiropractic treatment can result in vascular damage in an unknown number of cases" - so it's not surprising it caused some alarm. Based on published cases and insurance reports, complications from genuine chiropractic manipulation to the neck are, at worst, a problem for 1 in 500,000 patients so treated. That's just 0.0002 per cent. In contrast, a 1995 risk assessment study (Journal of Manipulative and Physiological Therapeutics, vol 18, p 530) reported that nonsteroidal anti inflammatory drugs can carry a 0.4 per cent risk per year of severe stomach ulceration, possibly leading to perforation and death. Would the reluctant patient have chosen painkillers rather than chiropractic had he known?

Can a person who had back surgery see a chiropractor?
Yes. It's an unfortunate fact that up to half of those who had spinal surgery discover a return of their original symptoms months or years later. They then face the prospect of additional surgery. This too common occurrence is known as "Failed Back Surgery Syndrome." Chiropractic may help prevent repeated back surgeries. In fact, if chiropractic care is initially utilized back surgery can often be avoided in the first place.

Is it OK to see a chiropractor if I'm pregnant?
Anytime is a good time for a better functioning nerve system. Pregnant mothers find that chiropractic adjustments improve their pregnancy and make delivery easier for themselves and their baby. Adjusting methods are always adapted to a patient’s size, weight, age, and condition of health.

Can a Chiropractor help with painful bone spurs?
Look for another cause of your pain! Many patients are told that they have "bone spurs" in their back or neck, with the implication that the bone spurs are the cause of their back pain. However, while bone spurs are an indication that there is degeneration of the spine, these bony growths are not usually the actual cause of the pain. The term "bone spurs" is really a bit of a misnomer, as the term "spurs" implies that they are "poking" some part of the spinal anatomy and causing pain. However, this is not at all true. Bone spurs are in fact smooth structures that form over a prolonged period of time. The medical term for bone spurs is osteophytes, and they represent an enlargement of the normal bony structure. Basically, osteophytes are a radiographic marker of spinal degeneration (aging) and are by and large a normal finding as we age. Over the age of 60, bone spurs are actually quite common. 

When a license is granted to a chiropractor, what does this mean to the public?
Through licensure, the board assures the public that the doctor has met certain credentialing criteria, and that he/she continues to abide by the laws and regulations of that state or province. The requirements to enter licensed chiropractic practice are defined by laws and regulations designed to protect the public's health, safety and welfare.

What can the public expect from a doctor of chiropractic?
While the core concept of practice is based on healing without drugs or surgery, the specific scope may vary according to the laws of a specific jurisdiction. However, patients may commonly expect: